KAPOSI SARCOMA IN SOUTH AFRICAN CHILDREN

D Cristina Stefan1, David K Stones2, Linda Wainwright3, Robert Newton4

1
Dept. of Paediatrics and Child Health, Tygerberg Hospital & University of Stellenbosch
2
Dept. of Paediatrics and Child Health, Universitas Hospital, University of the Free State, Bloemfontein
3
Dept. of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Wits University, Johannesburg
4
Epidemiology and Genetics Unit, Department of Health Sciences, University of York, Heslington York, United Kingdom

Table 4: Topography of lesions

Table 2: Annual numbers of KS recorded in the South
INTRODUCTION African Childrens Cancer Register (1998-2008), Site of lesions Number of % out of 63
mean age and survival to date. cases

The AIDS epidemic has contributed to an Skin Skin only 12 19.04

With mouth 5 7.93
abrupt increase of the incidence of Kaposi Mean and viscera
Total % of age %
sarcoma, especially in Sub-Saharan Africa, to cancer Ka total (mont Un- Surviva With lymph 4 6.34
Year s -posi cancers hs) Alive known l nodes
values tens of times higher than in the pre- With lung 3 4.76

epidemic era. There is, however, very little With lymph 3 4.76
1998 592 1 0.16 62 0 1 0 nodes and
viscera
literature concerning the clinical features of
1999 575 1 0.17 56 1 0 100 With mouth 2 3.17
this disease, its management and outcome in
With lymph 1 1.58
2000 716 9 1.2 54.3 1 8 11 nodes and
HIV-positive children in Africa.
mouth
2001 648 12 1.8 66.6 10 2 83 With bowel 1 1.58
With lymph 1 1.58
2002 599 14 2.3 78.2 5 0 35 nodes,
AIMS mouth and
viscera
2003 643 20 3.1 66 13 3 65
With bone 1 1.58
To examine retrospectively a series of 70 HIV- marrow
2004 723 24 3.3 79.3 16 3 66 With spleen 1 1.58
positive children with Kaposi sarcoma, from
With lung 1 1.58
several centres in South Africa, in order to 2005 650 24 3.6 104.1 10 7 41 and bowel
With liver 1 1.58
describe the usual clinical presentation as well 2006 592 16 2.7 82.5 13 3 81 TOTAL SKIN 36 57.14
as the management and its impact on the Mouth Mouth only 8 11.42
2007 564 13 2.3 82.7 12 12 92
Mouth and 1 1.42
course of the disease. nodes
2008 529 26 4.9 71.7 18 18 69 TOTAL MOUTH (including 16 25.39
mouth and skin)
Viscera only 8 12.69
PATIENTS AND METHODS TOTAL VISCERA 24 38.09
TOTAL 6302 160 2.2 73.3 99 56 61 Lymph Lymph 6 9.52
nodes nodes only
Data were analyzed from tumor registries and
And viscera 3 4.76
patient records in four South African hospitals,
TOTAL LYMPH NODES 19 30.15
from January1998 to December 2009. Skull only 1 1.58
Missing information 7 10
Table 3: associated symptoms and signs at
(Out of 70
presentation (in 38 cases) cases)
Symptom or sign Number of %
Table1: Patient outcome at the end of the recording Results
study period s The average age in this series was 73 months.
Cough (lesion on tongue) 5 16.12 The ratio of males to females was 1,65. The
OUTCOME NR. OF CASES % lesions were present on skin in 32 out of 63
Stridor 4 12.9 cases (50.79%), alone or in combination with
other sites. In 8 cases (12.69%) the tumor was
Respiratory distress 3 9.67 localized exclusively in the mouth, in a further 8
Alive (total) 28* 40
(swelling under tongue) patients (12.69%) exclusively in the viscera and
in 6 patients (9.52%) only in the lymph nodes.
Pulmonary oedema 1 3.22 Tuberculosis was associated with Kaposis
Alive with 10 14.28 sarcoma in 9 cases out of 38 (23.68%). The mean
progressive Swelling of the jaw 2 6.45 CD4+ lymphocyte count was 440 (SD=385). Only
disease 38 patients (54.28%) were taking combined
Epistaxis 1 3.22 antiretrovirals at the time of diagnosis. Twenty-
Alive on treatment 5 7.14 nine cases (41.42%) received chemotherapy with
Anasarca 5 16.12 Bleomycine, Vincristine and Adriamycin, alone
Ascites 1 3.22 or in combinations. While 32 patients (45.71%)
died after an average of 4 months, the average
Dead 32* 45.71 Diarrhoea 3 9.67 follow-up period for the remaining children was
Petechiae, conjunctival 2 6.45 16 months, with a maximum of 57 months.
Lost to follow-up 10* 14.28
bleeding

TOTAL* 70 100 Conclusions

Difficulty in urinating 1 3.22
Most of the time the clinical diagnosis was
suggested by the skin lesions; however, in a
Ulcerated nodes 1 3.22 large percentage of cases the tumor was hidden
Skull mass 1 3.22 in the mouth, viscera or lymph nodes. The CD4+
Acknowledgements lymphocyte count was not a predictor of Kaposi
Fever 1 3.22 sarcoma. The mortality remains high in South
PCF Permall for graphic design of poster. Africa, in spite of antiretroviral drugs and
TOTAL 31 100
chemotherapy.